Serum erythropoietin levels and blood component therapy after autologous bone marrow transplantation: implications for erythropoietin therapy in this setting.

To determine the potential impact of recombinant human erythropoietin (EPO) therapy in patients undergoing autologous bone marrow transplantation (BMT) and colony-stimulating factor therapy, we assayed endogenous serum EPO levels and noted blood transfusion requirements in relapsed non-Hodgkin's lymphoma patients treated with high-dose chemo-radiation therapy and autologous BMT. Hematocrit and reticulocyte counts were determined daily, and hematocrit was maintained in the 25-30% range by transfusion according to criteria established by our hospital transfusion committee. EPO levels were measured by radioimmunoassay and were determined at baseline, throughout therapy, and 2 and 3 months after BMT. Serum EPO levels increased more than 25-fold above baseline in most subjects after initiating chemoradiation therapy. No correlation was noted between serum EPO and hematocrit, reticulocyte count or serum creatinine. Total red blood cell units transfused ranged from 4 to 15 (mean 7.7). Mean total donor exposures (red blood cell plus platelet units transfused) were 83.6 units (range 16-175). Serum EPO levels increased early in the course of preparation for autologous BMT and remained elevated for at least 2-3 weeks thereafter although at a lower level. Red blood cell transfusions were required despite very high EPO levels after BMT. Red cell transfusions, moreover, accounted for only 9.2% (69 of 746) of total donor exposures and only 5.8% (42 of 746) of donor exposures during the interval when pharmacologic doses of erythropoietin might be of benefit. In contrast to the potential benefit of colony-stimulating factors such as G-CSF and GM-CSF in BMT, our study suggests limited value for erythropoietin therapy in this setting.     

Migrating calcified enterolith and chronic anemia: an unusual case presentation of a Meckel's diverticulum.

Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2 % of the population. The most common complications associated with a Meckel's diverticulum include obstruction, bleeding, and inflammation (7, 9, 11, 18-20). The estimated lifetime risk of developing symptoms with a Meckel's diverticulum is 4-6 % (16), with the risks of complications decreasing with age. Stones within Meckel's diverticulum are recognized as a rare complication in the adult population (13,15). However, it has not been reported in the pediatric age group. The authors describe a 19-month-old male who presented with intermittent abdominal pain and vomiting, chronic microcytic anemia and a calcified stone in the lower abdomen, who was found to have a Meckel's enterolith.     

文拉法辛与三环类抗抑郁药治疗抑郁症痊愈率的循证医学研究

目的　比较文拉法辛与三环抗抑郁药治疗抑郁症临床痊愈率的差异。方法　应用循证医学的Me-ta分析,采用固定效应模型(fixed effects model,FEM)法对符合标准的16项对照研究文献进行评价。结果　文拉法辛与三环抗抑郁药治疗抑郁症的临床痊愈率不同,差异有显著性(χ2=4.773,df=1,P<0.05);综合的ORs=1.36,95%CI为1.04~1.78。提示文拉法辛治疗抑郁症的临床痊愈率是三环抗抑郁药的 1.36倍。结论　治疗抑郁症,文拉法辛比三环抗抑郁药有更可靠的临床痊愈率。     

Fas/Apo-1在下肢静脉性溃疡的表达

目的 探讨Fas/Apo-1(CD95)在下肢静脉性溃疡的表达及意义.方法 采用流式细胞技术、半定量逆转录-聚合酶链反应(RT-PCR)和免疫组织化学方法检测不同体位下肢外周血和局部皮肤Fas/Apo-l(CD95)的表达.结果 溃疡组平卧位、下垂位血液中Fas/Apo-1(CD95)阳性细胞数分别为41.45±14.25、40.20±12.42,mRNA为0.74±0.33、0.78±0.22,皮肤中阳性细胞数为42.62±22.19、46.50±20.12,分别与无溃疡组和对照组比较,差异均有统计学意义(P<0.05);无溃疡组和对照组比较,差异无统计学意义(P>0.05);不同体位之间Fas/Apo-1(CD95)阳性细胞数和含量比较,差异无统计学意义(P>0.05).结论 Fas/Apo-1高表达可能与下肢静脉性溃疡发生密切相关.     

A randomized trial comparing double-drug and triple-drug therapy in primary cadaveric renal transplants

A controlled trial was carried out in 209 primary cadaveric renal transplants to compare the effects of cyclosporine and steroids (double therapy) with those of cyclosporine in lower initial dose, azathioprine, and steroids (triple therapy). Patients have been followed 1-36 months since transplantation. Actuarial two-year graft survival (double 74%, triple 76%) and two-year patient survival (double 90%, triple 93%) were similar for both groups. Further analysis of particular risk factors including age, diabetes, HLA matching, acute renal failure, and use of sequential Minnesota antilymphocyte globulin in patients with delayed graft function also showed similar outcomes with both immunosuppressive regimens. Initial hospitalization time, rate of rejection, incidence of serious infection, and rate of rehospitalization were not different. Mean CsA doses and mean trough whole-blood levels were higher in double-therapy patients at hospital discharge but not by three months posttransplant. There were no differences between the two groups in iothalamate clearance at any time. Hypertension was more frequent six months posttransplant in the triple-therapy group (p less than 0.05). Thus, similar results were obtained with both regimens, and except for hypertension no regimen appeared to have increased side effects up to three years posttransplant.     

颞颌关节继发性滑膜炎的临床诊断

颞颌关节滑膜炎分为原发性和继发性两种，颞颌关节紊乱综合症的滑膜炎为继发性滑膜炎。本文通过对１０６例颞颌关节紊乱综合症患者的临床检查、关节许氏位以及关节上腔造影的Ｘ线检查，同时对４２例进行了关节内窥镜检查，在此基础上探讨了继发性滑膜炎的临床诊断标准．作者认为急性滑膜炎主要是以关节疼痛和滑膜血管的改变为主，慢性滑膜炎的临床症状与滑膜组织改变以及关节骨组织的改变均有关系。